Knowledge Attitude and Practices (KAP)

Iraq, with particular focus on Kirkuk, Ninewa, Anbar and Duhok

Start Date

ASAP

Duration

4 months

Area of Expertise

Research, mental health, anthropology

1.1 Context

Present-day Iraq was ruled by the Ottoman Empire in the 16th Century, until World War I when its territories came under British colonial powers in 1918. Iraq gained independence from Britain in 1932, and the monarchy was ultimately overthrown in 1958. After 1979, under Saddam Hussein’s dictatorship, the country suffered 8 years of war with Iran, resulting in an estimated half a million deaths of Iraqis and Iranians. From 1986 to 1989, the Anfal Campaign and Kurdish genocide saw the killing of thousands of Assyrians and between 50,000 and 182,000 Kurds, of which 5,000 were massacred by chemical attacks by order of Saddam Hussein’s regime. Hussein’s invasion of Kuwait prompted the 1990-1991 Gulf War, with a reported 100,000 – 200,000 Iraqi deaths as a result of the conflict and the ensuing public health crisis exacerbated by the destruction to Iraq’s infrastructure and electric generating capacity. The country continued to be exposed to ongoing volatility, including the 2003-2011 US-led invasion of Iraq, where over 100,000 Iraqis lost their lives, and an estimated 300,000 civilians were injured and the ongoing tensions between Federal Iraq and Kurdistan Region of Iraq (KRI) surrounding disputed territories, namely Kirkuk Governorate. Finally, the 2014-2017 Iraq Civil War saw the destruction of Northern Iraq at the hands of Islamic State (IS).

Consequently, Iraq endured a long history of conflict, economic sanctions, and sectarian violence, resulting in a multigenerational legacy of survivors who suffered from ongoing traumatic events and human rights abuses. The current focus of the humanitarian response in Iraq is adopting strategies towards stabilization and recovery programming, in recognition of the aforementioned context in Iraq and its profound impacts on the population.

1.2 Mental Health in Iraq

Around 900 AD, Iraq was the birth place of the earliest recorded hospital to have incorporated provisions to care for mentally ill patients in Baghdad. It was documented that those suffering from mental illness were regarded with compassion. Psychiatric disorders, their diagnostic classifications and treatments were recorded and contributed to Baghdad’s distinguished academic institutions and wealth of resources in medical and scientific literature. The country’s economic and scholastic achievements deteriorated after the Mongol invasion and the subsequent Ottoman rule, which resulted in the destruction of over 8000 books – relinquishing much of Iraq’s intellectual pursuits to dormancy. Between the 1960s and 1970s, psychiatric services were re-established with the inauguration of mental health units within Iraq’s general hospitals. The momentum of strategic planning in mental health care gave rise to educational programmes in mental health and public awareness campaigns. By the 1980s, the efforts to instil mental health care were met with significant resource gaps in pharmaceuticals, integrated data systems, and formalized mental health education. The number of practicing psychiatrists diminished as a result of the discouraging professional conditions which were exacerbated by devastating wars, the fall of Saddam Hussein, the Iraq invasion, and IS.

Much of the affected populations in Iraq have experienced traumatic events that triggered, or worsened, psychological disorders. While the specialized needs of populations persist, the Iraqi health system is ill-equipped to manage the burden, due to a severe shortage of trained mental health care professionals, including psychologists and psychiatrists. Additionally, Iraq’s compromised health infrastructure and ongoing need for the rehabilitation of facilities hampers the revitalization of health services. **

1.3 Handicap International in Iraq

In Iraq, HI has been registered and operational in the Kurdistan Region of Iraq (KRI) since 1991, implementing development programming in the governorates of Duhok, Erbil, Sulaymaniyah and Halabja, in order to advocate for the rights of persons with disabilities and improve their access to services through support to Disabled Persons Organizations (DPOs). Since 2014, HI has scaled up its intervention in Iraq to respond to the humanitarian needs generated by the capture of territory by the ISIS-group, subsequent military operations and the widespread displacement of Iraqi populations. HI has become a lead implementing agency in the emergency response in the Health and Protection sectors, operating across Ninewa, Kirkuk and Diyala Governorates, and through a national partner in Baghdad and Anbar.

In line with HI Iraq’s Operational Strategy for the period 2017-2019, the global objective of HI programming in Iraq is to enhance the protection and resilience of conflict-affected communities in Iraq; an objective achieved through an operational framework of three central pillars:

1. Arms Risk Reduction: Reduce the impact of the Conventional Weapon (CW) and Improvised Explosive Devices (IED) for conflict-affected populations through Risk Education and land release
2. Health: Improve access to specific services for the most vulnerable people whose physical and functional and/or psychological integrity is compromised, through the provision of physical rehabilitation and Mental Health/Psychosocial Support (MHPSS) services
3. Access to Essential Services: Ensure equal access to essential services, protection and basic needs for all conflict-affected populations, including persons with disabilities

These pillars are complemented by three cross-cutting themes: a comprehensive approach to mine action, inclusion mainstreaming, and protection mainstreaming.

2.1 Background of the Project

The overall objective of the EU MADAD funded, MHPSS project is to improve access to quality mental health and psychosocial care in Iraq through enhancing technical capacities of governmental institutions at the ministry of health level, capacity building of stakeholders at national and governorate levels and promotion of mental health care. The two-year project is a Consortium, led by Action Against Hunger (ACF), in partnership with International Medical Corps (IMC), Premiere Urgence Internationale (PUI) and Humanity and Inclusion (HI).

For the promotion of mental health care component of the project, the Consortium will conduct a knowledge, attitude and practices surveys (KAP) in all targeted communities within 4 governorates to measure the current level of knowledge and awareness on existing MHPSS services and referral mechanisms, and the extent to which populations are able to access these services. The survey will also aim to capture baseline information on attitudes, practices and overall perception of the population with regards to MHPSS. The findings of the survey will be used to inform the implementation of campaign activities and guide the formulation of key messages, training and advocacy tools.

All partners of the Consortium will use the same methodology and tools to ensure synergy and harmonized approach, and to ensure that the data will be collected, analyzed and compared in the most effective and efficient manner. The survey will use a participatory and mixed-method approach to capture both qualitative and quantitative data on the level of knowledge, attitudes, practices, and overall perception on issues related to MHPSS and access concerns. Based on the data gathered and analyzed, the consortium will propose appropriate and prioritized activities and key messages for MHPSS awareness in all targeted governorates. The survey will also aim at understanding the best tools and media to be used to ensure effective outreach to the population including the most vulnerable persons. The survey will be complementary and cross analyzed to other needs and gaps assessment survey conducted by the consortium members within the project.

Questions on the survey will aim to capture the following data sets:

a. Knowledge, attitudes, practices and perceptions on issues related to MHPSS

b. Preferred modes of receiving information and awareness messages

c. Level of awareness and access to MHPSS services and referral mechanisms

d. Gaps and barriers to access MHPSS services and referral mechanisms

e. Recommendations to address challenges identified

Based on the findings of the KAP survey, the awareness campaign methodology, tools and messages will be refined to ensure they address any gaps and needs identified in the KAP survey. A refined awareness campaign methodology/toolkit will be developed and shared with all consortium members. All partners will be trained on the awareness campaign tools and methodology prior to delivering the activities.

OBJECTIVES OF THE CONSULTANCY

3.1 General Objective

Develop a comprehensive research and analysis of the knowledge, attitudes and practices (KAP) surrounding Mental Health in Iraq and design MHPSS awareness campaign tools and methodology, based on the findings.

3.2 Specific Objectives

· Develop a thorough understanding of how various factors influence the knowledge, perceptions and attitudes of mental health in Iraq, including social, cultural, ethnic, gender, historic and faith-based dimensions

· Identify local Mental Health frames and the key hidden messages within the multiple communities that exist across four governorates

· Lead the research and analysis of the KAP survey, working closely with the MEAL team, and other Technical Unit staff, in the design of survey methodology and awareness session and campaign tools

· Explore barriers to access MHPSS services within the four governorates and barriers to full participation in the community for people suffering from distress or any mental health conditions including social, economic, ethnic, education and awareness, political and physical

· Ensure inclusion of vulnerable groups in the awareness messages such as gender minorities, religious minorities, ethnic minorities and persons with disabilities including psychosocial disabilities

· Ensure awareness messages are available for people with varying literacy capacities

3.3 Deliverables

· Design and development of all KAP survey tools, to be reviewed by MHPSS Technical Coordinator

· With the support of the MHPSS Project Manager and the MHPSS Technical Coordinator, provide a 2-day KAP induction training for local enumerators and PSS workers who support the KAP research, which includes but is not limited to, the qualitative data collection methodology tools, cognitive interviewing skill building and interview translation guidelines

· Carry out the KAP survey across four governorates in accordance with the activity plan agreed upon by the MHPSS Technical Coordinator and MHPSS Project Manager and under the operational and safety guidelines of the Country Director

· Develop data analysis of the KAP survey and a report on the findings

· Develop the design of mental health awareness raising campaign toolkit packages for the four governorates (Note: the mental health awareness raising campaigns may differ according to the findings from each governorate and their subset communities)

· Delivery of 1 or 2-day workshop in Erbil for Consortium partners:

1. PowerPoint presentation on KAP survey findings and report (electronically share report with partners prior to the workshop);
2. Delivery of a training on the mental health awareness raising campaign toolkit packages to enable the Consortium to carry out the awareness activities with appropriate and creative tools

4. Stakeholders involved in the study

Mapping of key stakeholders for this study to be completed in collaboration with HI team, and Consortium partners, in the initial phase. Key stakeholders likely to be involved/consulted are community households, vulnerable groups, community leaders (including faith-based), traditional healers, community-based organizations, Department of Health Focal Points, etc.

5. Geographical coverage

The Consultant will work within HI Iraqi mission level, based in Erbil, and will partake in extensive travel to Kirkuk, Ninewa, Anbar and Duhok Governorates. The scope of the projects lies within the aforementioned four governorates, with HI team operating within Kirkuk and Ninewa Governorates, and consortium partners operating in Anbar and Duhok.

6. Timeline

Expected Start Date: August 2020

The consultancy start date is tentative due to the current COVID-19 restrictions on travel entering Erbil International Airport and movements between governorates within Iraq. The duration of the consultancy to be defined with flexibility of in-country and remote support, recognizing the possibility of quarantine and unforeseen challenges due to COVID-19.

7. Required background and skills

Education:

• Completion of Master’s Degree in Anthropology, Sociology, Psychology, International Relations, or other relevant fields

Experience:

• Proven experience developing research, data collection and/or capacity building tools within the realm of MHPSS, anthropology, sociology or protection
• At least two years of experience working with vulnerable populations where ethno-cultural, political, faith-based and other sensitive factors persist, preferably in the Middle East
• At least two years of experience working in a multi-linguistic/cultural context with translators, preferably in the Middle East
• Experience designing MHPSS awareness campaigns or IEC materials desirable

Skills:

• Adaptable and flexible to work in dynamic environments that may include ad-hoc changes to humanitarian access and unpredictable political, and at times, volatile situations
• Strong leadership capacity
• A solution-oriented mind-set and motivated self-started who requires little to no supervision
• Diplomatic and kind demeanour
• Exceptionally detail oriented in capturing KAP data through an anthropological lens
• Ability to transmit complex concepts and information into practical and meaningful tools
• Strong capacity to collaborate well with multiple external project stakeholders and internal staff
• Excellent English language skills required; Arabic and Kurdish language skills are an asset